Healthcare Provider Details

I. General information

NPI: 1942357587
Provider Name (Legal Business Name): U.S. ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 OAKINGTON ST
ABERDEEN PROVING GROUND MD
21005-5131
US

IV. Provider business mailing address

1252 EVERETTE RD
GUNPOWDER MD
21010-1618
US

V. Phone/Fax

Practice location:
  • Phone: 410-278-1814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number223451-4405
License Number StateUT

VIII. Authorized Official

Name: KATHY PRESPER
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 410-278-1814